[Experience with water births: a prospective longitudinal study of 9 years with almost 4,000 water births]

This prospective, longitudinal study spanning more than 9 years examines the influence of the birthing method, in particular water birth, on neonatal and maternal morbidity and mortality. Using questionnaires, maternal and neonatal data of 9,518 spontaneous singleton births with cephalic presentation, including 3,617 water births and 5,901 land births, were compared. Land births show significantly higher rates of episiotomies as well as third- and fourth-degree perineal tears. Waters births show a significantly higher rate of births 'without injuries', first- and second-degree perineal tears, vaginal and labial tears. The average loss of blood after water birth is -5.26 g/l; this is statistically significantly less than after land births at -8.08 g/l. In 69.7%, water births required no analgesic, compared to 30.3% for land births. Water and land births do not differ with respect to maternal and neonatal infections. After land births, there was a significantly higher rate of newborn complications with subsequent transfer to an external NICU. There were neither maternal nor neonatal deaths related to the birthing event. Water births are just as safe as land births if obstetrical guidelines are followed. Risks, such as preeclampsia, signs of infection, meconium-stained amniotic fluid and pathological CTG, are found more frequently in land births and indicate that a safe and prospective birth management is being followed.